Exactly how many Google calendars?

All this time I was jealous of people who had that expensive call-schedule-management software. Every time I was the subject of or dealt with a schedule snafu, the Bearded Economist would say: "You know, this is the kind of thing that computers are really good at."

And so I envied that expensive schedule management software. I thought you could plug in a bunch of rules (like, say, that doctors can't be in two places at once;  or that doctors can't work if they just worked a 24 hour overnight shift). Then you could copy in your holiday arrangements and let the magic happen. In a most beautiful world, it might notice if you signed in a for a shift that you weren't signed up for, and ask you what was going on. I bemoaned my 19 Google calendars* and the constant view and review required to assess for mistakes, and then stomach-curdling feeling when often, an entirely different mistake had occurred anyway.

Anyway, I was talking to a friend with that fancy software, and you know what? It's not actually that amazing. It's not programmable. It doesn't think. It's mostly just a shared place to keep the calendar, the calendar that a fallible human still has to make. It has some great associated features, like the ability to text or call someone directly from the schedule or other such thing.

Anyway, it's not actually that much better than my 21 Google calendars**, is what I'm saying. And the mistakes I try so hard to avoid, as a human, are not yet avoidable by obtaining a robot overlord. So I feel a bit better now.



* And counting; I'm spending a ridiculous amount of time considering whether to split one of these calendars into 3. On a weekend. No, everything's going just fine, why do you ask?

**I went for it.

Post-call bits and pieces

[redacted]

20 minutes

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Anatomy of a piece that wasn't

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Language Control

[redacted]

I got nothin'

[redacted]

Consult note #3

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Where'd you go, Bernadette?

by Maria Semple. 

Recommended to me by the wise Loupbleu. Greatly enjoyed. I highly recommend. 

Here is my favorite quote: 

"Are you quite done? People like you must create. If you don’t create, Bernadette, you will become a menace to society."

On a related note, I'm experimenting in thinking of myself as a creative person. So I'm  trying to put together a book proposal, similar to the stuff I put up here (and to many of the posts I took down, partially to see if I could use them in a book). 

Any title suggestions out there? 

Trying something new

[redacted]

Telegraph Avenue

Only for you would I have read "Telegraph Avenue", because I generally avoid anything having to do with birth or trauma on my time off. And, per expectations, I kind of hated it the first time through, because birth! trauma! midwifery politics! evil obstetricians! (Honestly, not one female OB, even though that's, like, statistically improbable these days.). But then I loved it, because Michael Chabon's language is just...fun. It's hard to read, for me, the first time through, because it's so very loaded. But then you puzzle it out and you laugh. I think this is how some people feel about poetry, right? And once you get past the birth trauma and his language play, his characters are great, too, so there's a lot reward there.

Anyway, I never would have read it either the first or subsequent times if not for your recommendation (was it Loupbleu?) and for The Bearded Economist, who read the recommendation and brough it home from the library. But it's really really good - so thank you.

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Speaking of comments: thanks for the rec, but I don't think the Skeptical OB is the right place for me. The best way I can think to describe it is that she is sort of the Bill O'Reilly of women's health discussion (lots of vitriol and dismissive statements, from what I can see). And I would like to be the Rachel Maddow? Or perhaps this metaphor breaks down. Regardless, the tone is all wrong for me.  Thanks for the suggestions, though.


I just finished the c-section piece (note: I was gently corrected that cesarean birth is the preferred, and overall nicer terminology; did you know that?), and we'll see if the editor takes it.

Passing

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Bruised

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Fluishly Yours

Dear ABOG;

Although I specifically set aside time this week to study for the upcoming MFM Oral boards, I hope you will accept, in lieu of passing that exam, this monograph entitled: "Care of the Sick Toddler(s) and Kindergartener: A Case of Cognitive Decline". Although not randomized, and an unethical experiment performed without IRB approval, I believe this study represents an important public health finding this winter, relevant to many parents of child-bearing age. It may even represent a delayed (2-5 years) form of postpartum depression. Of course, more research is needed; sadly, I seem to be deeply involved in advancing the field. 

Feverishly yours, 

Me

[redacted]

Recreational

[redacted]

Back!

You may (or most likely not) have noticed that this blog disappeared for a few days. Basically, several of you were kind enough to email me and say: "Hey, it's not that hard to figure out who you are."

And that was helpful. And it also required a reaction. So I took down the blog while I thought a bit. And what I ended up doing is taking down most of the old posts.

This is not because I'm not proud of them (although, wow, some of them are really longer than they need to be). And in truth, I never thought I was completely anonymous. But I was perhaps not terribly cautious, and from now on, I wanted to be a bit more careful.

I don't have the time right now to edit those old posts and make sure I'm ok with them being seen by a wider audience, so away they went to a secret hiding place. Those posts still exist, along with your treasured comments, in a more private area of the digital world. Really, truly, your comments are the best part, and part of what made taking everything down so very hard. But part of what made this fun was I just went through all of them and reveled in those comments, and they are still wonderful.

Anyway, the site is back up now - edited, redacted, but I think better. Because now I can keep writing, if with more awareness. And I'm hoping this new setup will mean that I am, in the end, less paralyzed.

Thank you all.

(Oh! If you were following the "other" blog - the one about saying Kaddish -  I made that one "invitation only". I believe I already added the people who emailed me last time wanting access, but please feel free to do so if I left you out.)

Publish able

[redacted]

Radioloab followed me to work

Not really, but you should go and listen to this. You should not, however, do so on an emotionally fraught trip to visit an ailing family member, because you will sob uncontrollably in seat 9C for most of your transcontinental flight, which will make the impeccably groomed 20-something in 9D very uncomfortable. Theoretically speaking.

Regardless, it was beautifully done, I thought, in that it bypasses a lot of the unhelpful rhetoric, and did so with tremendous respects for all the options presented. I don't agree with absolutely all the counselling or medical management in this story, and I have some unresolved questions (why the cesarean? why?) but so very worth it.

GI rounds

Every program has slang. For example, I cannot seem to stop calling a certain test "LENIS" (pronounced: Lenny's. As in, belonging to that greasy guy on "Laverne and Shirley"), which is what we called this test at my residency training site. The clumsy acronym stands for "Lower Extremity Non-Invasive Series" or something like that, but the rest of the world calls them lower extremity doppler ultrasounds and will persist in not understanding you if you keep calling them LENIS. 

Oh, and we used to call pre-eclampsia "P-E-T" (you would say every letter, you would never say "pet"); I think it once stood for "Pre-Eclampsia-Toxemia" [toxemia is a very, very old word for pre-eclampsia], and it's redundant, and not any shorter than just saying pre-eclampsia, but there you are. We said it, it's how I learned to talk OB, and it's awfully hard to get rid of that mother tongue. Multiple times every day, I look up to see a befuddled colleague looking at me, and then I have to translate the language of my residency-country into that of my new fellowship-land.

But here's one term that I have been introduced to at my fellowship program, and I really like it: GI rounds. GI as in gastroenterology. Rounds as in... you know, meeting to talk about patients and weighty clinical issues.

But at Large Urban Hospital, GI rounds means: Let's go eat! Or: the delivery guy from the Thai place is here! Or: the cafeteria closes in 10 minutes - go catch the elevator! *

 It's a little bit of a euphemism, but it sounds clinical, so it is very helpful when trying to maintain a professional veneer.

Thus it came to be that in the midst of my triage chaos tongiht, I walked into the room where my intern was performing an ultrasound after running around non-stop since coming on the labor floor 5 hours earlier. I stood by him, and very sternly said: Dr. F, you are late to GI rounds, and that is not acceptable. I will finish up here.

He got all the way to the hallway on autopilot; I think he was really convinced he was in some sort of serious trouble with me.  Then I heard him cracking up as he walked to the break room. 

*Unless you are actually a gastroenterologist. Maybe they go on OB rounds?

Mind your Gs and Ps

We talk about patient reproductive histories in short-hand - "She's a G2P1", meaning: she's had two pregnancies (this one counts) and is thus a gravida two, and one delivery; thus a para 1. That's an abbreviation for the longer format, which would be a G2P1001 - again, the G is the pregnancies, and the four digits of the P are various types of pregnancies she's experienced. Many med students use the mnemonic TPAL - the digits stand for, in turn, term pregnancies, premature deliveries, abortions, and live children.

But of course this becomes more complicated. First of all, "abortions" in this and most other medical language refers to any pregnancy loss prior to 20 weeks, regardless of whether is was spontaneous (or what we would call a miscarriage) or a termination. And twins always complicated matters- one pregnancy, two deliveries.

And finally, when you break it down to the short-hand - G2P1 - that one digit after the P refers to the "L" number, the living children this patient has. I was always taught that the "L" digit did not really mean "currently alive" but rather was a reference to children that had survived the neonatal period. That is, it was no longer part of the obstetric history if their 4 year old died in a car accident; that patient, with no living children, would still be a P1. It's tragic, yes, but unlikely to be related to the pregnancy, labor, or delivery we were thinking about now.

I'm seeing my residents, however, use it differently: as a notation for how many live children this patient actually has. The above patient would be presented by them as a P0; she has no children at home.. Arguably, that's a way of melding social history with obstetric history. And arguably, more appropriate.

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None of this terminology ends up being short-hand, in the end, as the terminology has so many possible meanings that an explanation must inevitably accompany it. That is, is the G3P1011 someone who had a term delivery after a six-week miscarriage? This is medically low-risk, and not a red flag for her pregnancy. Or is she someone who had a term delivery, followed by an 17-week intrauterine loss? Or a second trimester termination? Both of those people would have very different concerns and follow-ups, as their bodies would have been subjected to extremely different physiologic and pathologic processes.

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In any case, though, I recently took care of a G9 P0. And you don't need much explanation to know how terrible that is. Nine pregnancies; no living children.

Most of these were in other countries, with minimal medical care so far as I can tell. And yet, it is amazing to me that she has the strength to even try again. This time, things seem to be progressing uneventfully, which is really the best you can hope for in any pregnancy.